Posted by: blog4globalhealth | 10/06/2011


Sawe and Warren blog cuts to HIV vaccine development at DA threaten major new advances, future opportunities

The Department of the Army is set to slash 73 percent of the U.S. Military HIV Research Program’s (MHRP) Army research budget for FY 13 through FY17. Incredibly, this cut comes on the heels of exciting and promising results from the MHRP scientific team identifying a correlate of risk for an HIV vaccine. This recent work, together with the MHRP’s landmark RV144 study results in 2009 showing for the first time ever that an HIV vaccine was possible, are among the most important advances in HIV prevention research. Since 1986, the Congressionally mandated MHRP has worked to develop a safe, globally effective HIV vaccine and began providing critical support for President’s Emergency Plan for AIDS Relief (PEPFAR) programs in Africa in 2004. Organizations dedicated to HIV research are now uniting to urge the Pentagon to restore this funding in FY 2013 and beyond, sustaining America’s position as world leader in AIDS vaccine research capacity and continuing research that led to the first ever partially effective AIDS vaccine.

On Sept. 19, the follow-up studies to the 2009 MHRP-led HIV vaccine clinical trial, RV144 – which was the first ever to demonstrate modest effectiveness in preventing HIV infection – were presented. MHRP announced that it had identified two important molecular clues – two antibodies whose presence correlated with an increase or decrease in the rate of HIV infection. With these findings we are the closest we have come to discovering correlates for an HIV vaccine after decades of research. In the long term, an effective vaccine will not only save lives, but it will also save the U.S. government money through reduced health care and other costs.

It is not widely known that the U.S. military has helped develop eight licensed vaccines, and its product-oriented research is what led to the success seen in the RV144 trial. The army has been conducting medical research in Thailand for 50 years and in Kenya for more than 40 years, and has helped those countries combat many diseases including HIV and malaria. In addition, MHRP works with other U.S. government programs in a coordinated and strategic approach. It has built unique relationships and infrastructures in Africa and Thailand that no other U.S. institution has, and that many depend on. This HIV work has helped build and support a sustainable framework for clinical research and public health infrastructure strengthening in West, East, and Southern Africa. The work they do is not a duplication of HIV research efforts; it leverages and augments other U.S.-funded activities, and to lose it will affect this and other vital world health programs.

Working under the PEPFAR since 2004, MHRP has developed prevention, and care and treatment programs in Kenya, Nigeria, Tanzania, and Uganda. As a result of these efforts, ambitious program goals in HIV prevention, care and program management have been achieved, that also contribute to regional security. MHRP provides PEPFAR support to a total catchment population of nearly 12 million people in Africa, and they currently have 94,000 people on life-saving ARTs.

One example of how MHRP has supported PEPFAR programs is in Kericho, Kenya where a prevention of mother to child transmission (PMTCT) program has been the foundation for HIV care and treatment and has resulted in support for more than 400,000 women. The collaboration between research and PEPFAR programs at MHRP provides a critical platform from which to implement operational research and public health evaluations that assist ongoing efforts to improve and amplify the effect of PEPFAR programs. For example, the MHRP Kericho site pioneered integrated TB/HIV and PMTCT clinics, now models for the Ministry of Health in Kenya. It also conducting key operational research in effort to gauge PEPFAR roll-out and inform policy makers in the areas of viral load monitoring of antiretroviral therapy, PMTCT services, and the use of traditional male circumcision ceremonies for HIV prevention messages.

If MHRP funding is drastically cut in the coming years as proposed, it will set back leading scientific research on a course to finding a vaccine, the best weapon against HIV. At the same time it will put to waste all the resources that have been used over the years to develop a world class HIV clinical research infrastructure and impair ongoing and critical efforts to increase the impact of the PEPFAR program by delivering lifesaving drugs and prevention tools more effectively and efficiently. The Pentagon needs to capitalize on its success, and move forward with its sister agencies, to meet and defeat the national and global threat of HIV.
Fred Sawe is the deputy director, Kenya Medical Research Institute/Walter Reed Project HIV Program in Kericho, Kenya.
Mitchell Warren is the executive director of AVAC.


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